Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 103258 | CA |
NPI | 1629532916 |
---|---|
Provider Name | Dr. Ben Rosenbaum |
First Address | Los Angeles, CA 90095-3075 |
Second Address | Los Angeles, CA 90095-3075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2019 |
Last Update Date | 30/01/2019 |